CMS aims to appease providers with final ACO Rules

by Brendon Nafziger, DOTmed News Associate Editor | October 20, 2011
The Centers for Medicare and Medicaid Services released final rules for its accountable care organization regulations Thursday, easing some rules in changes aimed at mollifying health care providers who balked when the proposed ACO guidelines were first floated at the end of March.

In the new rules, the CMS allows providers to choose, at first, a "savings only" track that doesn't expose them to financial risk, drops the number of quality measures from 65 to 33, lets doctors know who's participating in the program (before they were in the dark until the end of the ACO contract), modifies some electronic health record demands, and provides for staggered start dates throughout next year. It also lets federally qualified health centers and rural health clinics join -- previously, they were left out.

"Taken together, these changes and numerous others create a more feasible and attractive on-ramp for a diverse set of providers and organizations to participate as ACOs," CMS chief Donald Berwick wrote Thursday in a New England Journal of Medicine perspective piece, announcing the regulations.

The ACO program is designed to help doctors better coordinate care over a defined patient population. Advocates say it can help the U.S. health care system save money by, for instance, keeping chronically sick patients out of the hospital and in their communities. Berwick called the coordinated care model, which the ACO aims to promote, Medicare's "most promising path toward financial sustainability."

"Whether provided through ACOs or an alternative innovation opportunity, coordinated care is meant to allow providers to break away from the tyranny of the 15-minute visit, instill a renewed sense of collegiality, and return to the type of medicine that patients and families want," he wrote.

Bean-counters with CMS have suggested the program, likely to affect only 4 percent of Medicare beneficiaries, could save up to $900 million dollars.

But the medical community is still digesting the 696-page-long guidelines. "HIMSS staff analyzing now for impacts," Dave Roberts, vice president of government relations with HIMSS, tweeted Thursday.

Read more: Here's a handy chart showing the difference between the proposed and the final rules: http://www.cms.gov/aco/downloads/Appendix-ACO-Table.pdf

Here are the final rules: http://www.ofr.gov/OFRUpload/OFRData/2011-27461_PI.pdf

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